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Why bogus therapies seem to work

Many diseases are cyclical
Placebo effect
Bets are "hedged"
Original diagnosis may be wrong
Mood improvement or cure
Psychological investment in alternatives

There is a website worth visiting if you are concerned about the benefits or otherwise of alternative therapies (www.quackwatch.com), but note that Bandolier does not endorse the contents of the site or its conclusions). One page is devoted to why 'bogus' therapies seem to work. The points are well made and some apply just as much to conventional as alternative therapies. Most of the points are where non scientific belief can be nullified by proper scientific method.

That is the main reason why high quality studies of alternative therapies are negative, while lower quality studies are positive. If bias exists in the usual clinical situation, it is even more relevant for alternative therapies where belief in the value of the therapy is very strong.

Many diseases are self-limiting


The old saying is that a cold will go away in a week or in seven days if you treat it. Determining whether an intervention has made a difference is therefore difficult. Unless rigorous study methods are applied, an apparent benefit cannot be ascribed to the intervention or the natural course of the disease.

Many diseases are cyclical


Allergies, multiple sclerosis, arthritis and gastrointestinal problems like irritable bowel syndrome all have their ups and downs. Sufferers may seek therapy on a down, so that when an up comes that has to be due to the therapy, doesn't it. Again, only rigorous study design combats this.

Placebo effect


Both the above contribute to what is called a placebo effect. It can be seen as the natural course of things. For instance, some people need no pain relief after surgery [1], making a pre-emptive intervention which claims to reduce pain after surgery a sure win. There will always be some people publicly to declaim its value. Natural "placebo" rates depend on what the problem is and what the benefit is. There will always be some people who benefit without an intervention.

Bets are "hedged"


"My auntie was under the doctor for six months, but it was only when she started on homeopathy that she got better". The fact that the poor infantry slaved away for six months is forgotten in the glamour of magic.

Original diagnosis may be wrong


Bandolier has highlighted the difficulty of diagnosis. If the diagnosis is wrong, then miraculous cures are less miraculous.

Mood improvement or cure


Alternative healers often have much more time to spend with their patient than a harassed GP loaded down with kilograms of guidelines and tight prescribing budgets. Is it any wonder that alternative healers can make patients feel better? That mood change is sometimes seen as the cure.

Psychological investment in alternatives


Alternative healing can be as simple as some herbal remedy bought from a shop. Sometimes it can involve huge amounts of time, massive involvement of the family, and an intense psychological investment in believing that something (anything) will work. It is not surprising, then, that many people find some redeeming value in the treatment.

Reference:

  1. HJ McQuay, RES Bullingham, RA Moore, PJD Evans, JW Lloyd. Some patients don't need analgesics after surgery. Journal of the Royal Society of Medicine 1982 75, 705-708.


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